scholarly journals Subacute Presentation of Central Cord Syndrome Resulting from Vertebral Osteomyelitis and Discitis: A Case Report

2020 ◽  
Vol 4 (2) ◽  
pp. 267-271
Author(s):  
Thomas Dang ◽  
Fanglong Dong ◽  
Greg Fenati ◽  
Massoud Rabiei ◽  
Melinda Cerda ◽  
...  
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Skilled Nursing Facility ◽  
Vertebral Osteomyelitis ◽  
Delayed Diagnosis ◽  
Central Canal ◽  
Clinical Syndrome ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Central Cord Syndrome

Introduction: Central cord syndrome (CCS) is a clinical syndrome of motor weakness and sensory changes. While CCS is most often associated with traumatic events. There have been few documented cases being caused by abscesses resulting from osteomyelitis. Case Report: A 56-year-old male presented to a regional trauma center complaining of excruciating neck and bilateral upper extremity pain. Computed tomography of the cervical and thoracic regions revealed severe discitis and osteomyelitis of the fourth and fifth cervical (C4-C5) with near-complete destruction of the C4 vertebral body, as well as anterolisthesis of C4 on C5 causing compression of the central canal. Empiric intravenous (IV) antibiotic therapy with ampicillin/sulbactam and vancomycin was initiated, and drainage of the abscess was scheduled. After the patient refused surgery, he was planned to be transferred to a skilled nursing facility to receive a six-week course of IV vancomycin therapy. A month later, patient returned to emergency department with the same complaint due to non-compliance with antibiotic therapy. Discussion: Delayed diagnosis and treatment of osteomyelitis can result in devastating neurological sequelae, and literature supports immediate surgical debridement. Although past evidence has suggested surgical intervention in similar patients with presence of abscesses, this case may suggest that antibiotic treatment may be an alternative approach to the management of CCS due to an infectious etiology. However, the patient had been non-compliant with medication, so it is unknown whether there was definite resolution of the condition. Conclusion: In patients presenting with non-traumatic central cord syndrome, it is vital to identify risk factors for infection in a thoroughly obtained patient history, as well as to maintain a low threshold for diagnostic imaging.

scholarly journals Telehealth Implementation in a Skilled Nursing Facility: Case Report for Physical Therapist Practice in Washington

2016 ◽  
Vol 96 (2) ◽  
pp. 252-259 ◽  
Author(s):  
Alan Chong W. Lee ◽  
Michael Billings
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Human Factors ◽  
Clinical Outcomes ◽  
Physical Therapist ◽  
Skilled Nursing Facility ◽  
Cost Savings ◽  
Pilot Program ◽  
Nursing Facility ◽  
Skilled Nursing

Background and Purpose Telehealth is defined as the delivery of health-related services and information via telecommunication technologies. The purposes of this case report are: (1) to describe the development, implementation, and evaluation of a telehealth approach for meeting physical therapist supervision requirements in a skilled nursing facility (SNF) in Washington and (2) to explore clinical and human factors of physical therapist practice in an SNF delivered via telehealth. Case Description In 2009, Infinity Rehab conducted a pilot program to determine whether telehealth could be used to meet physical therapist supervision requirements in an SNF. In 2011, language allowing telehealth physical therapy was approved by the Washington Board of Physical Therapy (Board). In 2014–2015, telehealth outcomes were evaluated in a 51-person sample at an Infinity Rehab SNF. Cost savings of telehealth implementation from 2011 to 2015 were estimated. Outcomes The Board deemed the telehealth pilot program a success and subsequently established telehealth practice language for physical therapy. Both human factors and clinical outcomes were required to implement a successful telehealth practice. Clinical outcomes and user satisfaction in telehealth and nontelehealth groups were equivalent. Cost savings were identified. Discussion Human factors, such as the need for provider education in appropriate bedside manner with a telehealth session, were identified. Since 2011, more than 1,000 telehealth physical therapy sessions were conducted at Infinity Rehab SNFs in Washington State. In the future, alternative payment models focused on valued-based clinical outcomes may facilitate wider telehealth adoption in physical therapy. Future research on efficacy and cost-effectiveness is needed to promote broader adoption of telehealth physical therapy in SNFs. This experience demonstrates that telehealth implementation in an SNF for the purpose of physical therapy re-evaluation is a feasible alternative to in-person encounters.

Mycobacterium bovis BCG Causing Vertebral Osteomyelitis (Pott’s Disease) Following Intravesical BCG Therapy

1999 ◽  
Vol 37 (6) ◽  
pp. 2106-2108 ◽  
Author(s):  
Ibrahim S. Aljada ◽  
John K. Crane ◽  
Nancy Corriere ◽  
Datta G. Wagle ◽  
Daniel Amsterdam
Keyword(s):  
Mycobacterium Bovis ◽  
Skilled Nursing Facility ◽  
Vertebral Osteomyelitis ◽  
Clinical History ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Bcg Therapy ◽  
Intravesical Bcg ◽  
Intravesical Bcg Therapy ◽  
Liquid Chromatographic

We report a case of Mycobacterium bovis BCG vertebral osteomyelitis in a 79-year-old man 2.5 years after intravesical BCG therapy for bladder cancer. The recovered isolate resembled M. tuberculosis biochemically, but resistance to pyrazinamide (PZA) rendered that diagnosis suspect. High-pressure liquid chromatographic studies confirmed the diagnosis of M. bovis BCG infection. The patient was originally started on a four-drug antituberculous regimen of isoniazid, rifampin, ethambutol, and PZA. When susceptibility studies were reported, the regimen was changed to isoniazid and rifampin for 12 months. Subsequently, the patient was transferred to a skilled nursing facility for 3 months, where he underwent intensive physical therapy. Although extravesical adverse reactions are rare, clinicians and clinical microbiologists need to be aware of the possibility of disseminated infection by M. bovis BCG in the appropriate setting of clinical history, physical examination, and laboratory investigation.

scholarly journals Targeting heart failure rehospitalizations in a skilled nursing facility: A case report

Heart & Lung ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 392-396 ◽  
Author(s):  
Mary A. Dolansky ◽  
Luann Capone ◽  
Erin Leister ◽  
Rebecca S. Boxer
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

Sign in / Sign up

Export Citation Format

Share Document